Multiple rhythm template monitoring

ABSTRACT

A system for providing information about a patient&#39;s heart includes one or more electrodes that receive signals from electrical activity of the heart over one or more heart beat cycles. The system is characterized by an electronic processor coupled to the one or more electrodes to: receive the signals from the one or more electrodes; execute an automated set-up routine that processes the signals to automatically provide at least some set-up results for new mapping configurations; and/or process the signals with beat detection and beat acceptance criteria for new or existing mapping configurations to provide information about how well the signals match one or more of the new or existing mapping configurations.

CROSS-REFERENCE TO RELATED APPLICATION

This application claims priority to Provisional Application No.62/233,339, filed Sep. 26, 2015, which is herein incorporated byreference in its entirety.

TECHNICAL FIELD

This disclosure relates to systems and methods for providing informationabout a patient's heart and, in particular, to systems and methods formonitoring and electro-anatomically mapping the patient's heart.

BACKGROUND

Use of minimally invasive procedures, such as catheter ablation, totreat a variety of heart conditions, such as supraventricular andventricular arrhythmias, is becoming increasingly prevalent. Often,these procedures involve the mapping of electrical activity in the heartat various locations on the endocardium surface, referred to as cardiacmapping, to identify the mechanism of the arrhythmia followed by atargeted ablation. To perform the cardiac mapping, a catheter with oneor more electrodes can be inserted into the patient's heart chamber.

Cardiac mapping techniques include contact mapping, near-contactmapping, and non-contact mapping. In contact mapping, one or morecatheters are advanced into the heart and physiological signalsresulting from the electrical activity of the heart are acquired withone or more electrodes located at the catheter distal tip afterdetermining that the tip is in stable and steady contact with theendocardium surface of a heart chamber. The location and electricalactivity can be measured on a point-by-point basis at, for example,about 50 to 200 points on the internal surface of the heart to constructan electro-anatomical depiction of the heart. In near-contact mapping, amovable catheter having multiple spatially distributed electrodes isplaced in a heart chamber of interest and moved to one or more locationswithin the chamber of interest, where the electrodes are on or near,such as within millimeters of, the endocardium surface of the heartchamber. Measurements are taken automatically at each of the locationsof the catheter, without determining whether the electrodes are incontact with the surface of the heart. These measurements are analyzedto detect the endocardium surface of the heart chamber in the vicinityof the catheter. The location of the catheter, e.g., a location providedby a tracking system, and the measurements from the electrodes are usedto reconstruct the chamber anatomy, where, for example, 20,000measurements may be made to construct an electro-anatomical depiction ofthe heart. As the tracked catheter is moved inside the chamber, apartial or complete representation of the chamber anatomy can beconstructed. In non-contact mapping, a multiple electrode catheter isplaced in the heart chamber of interest and the catheter is deployed toassume a three dimensional shape. Using the signals detected by thenon-contact electrodes and information on chamber anatomy and relativeelectrode location, the system calculates and provides physiologicalinformation regarding the endocardium surface of the heart chamber. Inthese cardiac mapping techniques, the generated map may then serve asthe basis for deciding on a therapeutic course of action, such as tissueablation, to alter the propagation of the heart's electrical activityand to restore normal heart rhythm.

While mapping a patient's heart, the patient may present multipledifferent types of cardiac rhythms, mixed in time, which the user wantsto map and/or the patient may present a paced rhythm. Typically, themapping system is set to capture one type of cardiac rhythm for acurrent map. If the cardiac rhythm changes, the new type of cardiacrhythm is not added to the current map. To capture signals associatedwith the new cardiac rhythm type, the mapping system must bereconfigured to an existing cardiac mapping configuration that matchesthe current cardiac rhythm or the mapping system must be reconfigured tocapture the current cardiac rhythm. However, determining whether anexisting cardiac mapping configuration can be used for the currentcardiac rhythm can be a difficult and time consuming process andprogramming a new mapping configuration into the mapping system can takeanywhere from 10 seconds to more than a minute, either of which mayresult in lost data and frustration.

SUMMARY

Example 1 is a system for providing information about a patient's heart.The system includes one or more electrodes that receive signals fromelectrical activity of the heart over one or more heart beat cycles. Insome embodiments, the system is characterized by an electronic processorcoupled to the one or more electrodes to: receive the signals from theone or more electrodes; execute an automated set-up routine thatprocesses the signals to automatically provide at least some set-upresults for new mapping configurations; and process the signals withbeat detection and beat acceptance criteria for the new or existingmapping configurations to provide information about how well the signalsmatch one or more of the new or existing mapping configurations. In someembodiments, the system is characterized by an electronic processorcoupled to the one or more electrodes to receive the signals from theone or more electrodes and execute an automated set-up routine thatprocesses the signals to automatically provide at least some set-upresults for new mapping configurations. In some embodiments, the systemis characterized by an electronic processor coupled to the one or moreelectrodes to receive the signals from the one or more electrodes andprocess the signals with beat detection and beat acceptance criteria fornew or existing mapping configurations to provide information about howwell the signals match one or more of the new or existing mappingconfigurations.

Example 2 is the system of Example 1, wherein the electronic processorexecutes the automated set-up routine and processes the signals with thebeat detection and beat acceptance criteria for the existing mappingconfigurations in parallel.

Example 3 is the system of any of Examples 1 and 2, wherein theelectronic processor executes the automated set-up routine at one ormore of a predetermined time interval, once every heart beat cycle, andonce per second.

Example 4 is the system of any of Examples 1-3, wherein the automatedset-up routine provides the new mapping configurations in response tochanges in the signals.

Example 5 is the system of any of Examples 1-4, wherein the new mappingconfigurations are updated and displayed while matching the signals toat least one of the existing mapping configurations and displaying thedegree of matching between the signals and the at least one of the newor existing mapping configurations.

Example 6 is the system of any of Examples 1-5, wherein information formaking a determination about which of the new or existing mappingconfigurations most closely matches the signals is displayed.

Example 7 is the system of any of Examples 1-6, comprising a userinterface for switching from mapping the signals using one of theexisting mapping configurations to mapping the signals using another oneof the existing mapping configurations or one of the new mappingconfigurations.

Example 8 is the system of any of Examples 1-7, wherein the electronicprocessor determines which of the new mapping configurations and theexisting mapping configurations are redundant.

Example 9 is the system of any of Examples 1-8, wherein the electronicprocessor automatically switches from mapping the signals using one ofthe existing mapping configurations to mapping the signals using anotherone of the existing mapping configurations or one of the new mappingconfigurations.

Example 10 is a method for providing information about a patient'sheart. The method includes receiving signals from electrical activity ofthe heart over one or more heart beat cycles at one or more electrodesand is characterized by the steps of: receiving the signals at anelectronic processor that is coupled to the one or more electrodes;executing, by the electronic processor, an automated set-up routine thatprocesses the signals to automatically provide at least some set-upresults for new mapping configurations; and processing the signals, bythe electronic processor, with beat detection and beat acceptancecriteria for existing mapping configurations to provide informationabout how well the signals match one or more of the existing mappingconfigurations.

Example 11 is the method of Example 10, wherein the steps of executingthe automated set-up routine and processing the signals with the beatdetection and beat acceptance criteria for the existing maps areperformed in parallel.

Example 12 is the method of any of Examples 10 and 11, includingdisplaying information about the degree of matching between the signalsand a current mapping configuration of the existing mappingconfigurations and displaying information about the degree of matchingbetween the signals and at least one other mapping configuration of theexisting mapping configurations.

Example 13 is the method of any of Examples 10-12, including updatingthe new mapping configurations in response to changes in the signals anddisplaying updated new mapping configurations.

Example 14 is the method of any of Examples 10-13, including switchingfrom mapping the signals using one of the existing mappingconfigurations to mapping the signals using another one of the existingmapping configurations or one of the new mapping configurations.

Example 15 is the method of any of Examples 10-14, including determiningwhich of the new mapping configurations and the existing mappingconfigurations more closely matches the signals and determining which ofthe new mapping configurations and the existing mapping configurationsare redundant.

Example 16 is a system for providing information about a patient'sheart. The system includes one or more electrodes that receive signalsfrom electrical activity of the heart over one or more heart beat cyclesand an electronic processor coupled to the one or more electrodes. Insome embodiments, the electronic processor is to receive the signalsfrom the one or more electrodes, execute an automated set-up routinethat processes the signals to automatically provide at least some set-upresults for new mapping configurations, and process the signals withbeat detection and beat acceptance criteria for the new or existingmapping configurations to provide information about how well the signalsmatch one or more of the new or existing mapping configurations. In someembodiments, the electronic processor is to receive the signals from theone or more electrodes and execute an automated set-up routine thatprocesses the signals to automatically provide at least some set-upresults for new mapping configurations. In some embodiments, theelectronic processor is to receive the signals from the one or moreelectrodes and process the signals with beat detection and beatacceptance criteria for the new or existing mapping configurations toprovide information about how well the signals match one or more of thenew or existing mapping configurations.

Example 17 is the system of Example 16, wherein the electronic processorexecutes the automated set-up routine and processes the signals with thebeat detection and beat acceptance criteria for the existing mappingconfigurations in parallel.

Example 18 is the system of Example 16, wherein the electronic processorexecutes the automated set-up routine at one or more of a predeterminedtime interval, once every heart beat cycle, and once per second.

Example 19 is the system of Example 16, wherein the automated set-uproutine provides the new mapping configurations in response to changesin the signals and the new mapping configurations are updated anddisplayed while matching the signals to one or more of the new orexisting mapping configurations.

Example 20 is the system of Example 16, including a user interface,wherein the degree of matching between the signals and at least two ofthe new or existing mapping configurations is displayed on the userinterface.

Example 21 is the system of Example 16, including a user interface,wherein information for making a determination about which of the new orexisting mapping configurations most closely matches the signals isdisplayed on the user interface.

Example 22 is the system of Example 16, including a user interface forswitching from mapping the signals using one of the existing mappingconfigurations to mapping the signals using another one of the existingmapping configurations or one of the new mapping configurations.

Example 23 is the system of Example 16, wherein the electronic processordetermines which of the new mapping configurations and the existingmapping configurations are redundant.

Example 24 is the system of Example 16, wherein the electronic processorautomatically switches from mapping the signals using one of theexisting mapping configurations to mapping the signals using another oneof the existing mapping configurations or one of the new mappingconfigurations.

Example 25 is a system for providing information about a patient'sheart. The system including one or more electrodes that receive signalsfrom electrical activity of the heart over one or more heart beat cyclesand an electronic processor coupled to the one or more electrodes. Theelectronic processor is to receive the signals from the one or moreelectrodes, execute an automated set-up routine that processes thesignals to automatically provide at least some set-up results for newmapping configurations, and process the signals with beat detection andbeat acceptance criteria for existing mapping configurations to provideinformation about how well the signals match the existing mappingconfigurations, wherein the electronic processor executes the automatedset-up routine and processes the signals with the beat detection andbeat acceptance criteria for the existing mapping configurations inparallel. The system also includes a user interface, wherein informationfor making a determination about which of the existing mappingconfigurations more closely matches the signals is displayed on the userinterface.

Example 26 is the system of Example 25, wherein the automated set-uproutine provides the new mapping configurations in response to changesin the signals and the new mapping configurations are updated anddisplayed on the user interface.

Example 27 is the system of Example 25, wherein the degree of matchingbetween the signals and a current mapping configuration of the existingmapping configurations is displayed on the user interface while mappingthe signals to a current map associated with the current mappingconfiguration and the degree of matching between the signals and atleast one other mapping configuration of the existing mappingconfigurations is displayed on the user interface while mapping thesignals to the current map.

Example 28 is the system of Example 25, wherein a user can switch frommapping the signals using a current mapping configuration of theexisting mapping configurations to mapping the signals using another oneof the existing mapping configurations or one of the new mappingconfigurations via the user interface.

Example 29 is the system of Example 25, wherein the electronic processoris configured to automatically switch from mapping the signals using acurrent mapping configuration of the existing mapping configurations tomapping the signals using another one of the existing mappingconfigurations or one of the new mapping configurations.

Example 30 is a method for providing information about a patient'sheart. The method including receiving signals from electrical activityof the heart over one or more heart beat cycles at one or moreelectrodes, receiving the signals at an electronic processor that iscoupled to the one or more electrodes, executing, by the electronicprocessor, an automated set-up routine that processes the signals toautomatically provide at least some set-up results for new mappingconfigurations, and processing the signals, by the electronic processor,with beat detection and beat acceptance criteria for existing mappingconfigurations to provide information about how well the signals matchone or more of the existing mapping configurations.

Example 31 is the method of Example 30, wherein executing the automatedset-up routine and processing the signals with the beat detection andbeat acceptance criteria for the existing maps is performed in parallel.

Example 32 is the method of Example 30, including displaying informationabout the degree of matching between the signals and a current mappingconfiguration of the existing mapping configurations and displayinginformation about the degree of matching between the signals and atleast one other mapping configuration of the existing mappingconfigurations.

Example 33 is the method of Example 30, including updating the newmapping configurations in response to changes in the signals anddisplaying updated new mapping configurations.

Example 34 is the method of Example 30, including switching from mappingthe signals using one of the existing mapping configurations to mappingthe signals using another one of the existing mapping configurations orone of the new mapping configurations.

Example 35 is the method of Example 30, including determining which ofthe new mapping configurations and the existing mapping configurationsmore closely matches the signals and determining which of the newmapping configurations and the existing mapping configurations areredundant.

While multiple embodiments are disclosed, still other embodiments of thepresent disclosure will become apparent to those skilled in the art fromthe following detailed description, which shows and describesillustrative embodiments of the disclosure. Accordingly, the drawingsand detailed description are to be regarded as illustrative in natureand not restrictive.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a diagram illustrating an electro-anatomical mapping systemfor mapping multiple different types of cardiac rhythms, which are mixedin time, according to embodiments of the disclosure.

FIG. 2 is a flowchart diagram illustrating an automatedelectro-anatomical mapping process, according to embodiments of thedisclosure.

FIG. 3 is a diagram illustrating a process for determining which mappingconfiguration more closely matches the cardiac rhythm signals, accordingto embodiments of the disclosure.

FIG. 4 is a diagram illustrating a user interface display that displaysa degree of matching between incoming data and three existing cardiacmapping configurations, according to embodiments of the disclosure.

While the disclosure is amenable to various modifications andalternative forms, specific embodiments have been shown by way ofexample in the drawings and are described in detail below. Theintention, however, is not to limit the disclosure to the particularembodiments described. On the contrary, the disclosure is intended tocover all modifications, equivalents, and alternatives falling withinthe scope of the disclosure as defined by the appended claims.

DETAILED DESCRIPTION

During cardiac mapping of multiple different types of cardiac rhythms,mixed in time, the cardiac rhythm may change spontaneously or due tosome intentional act, such as pacing of the heart. When this occurs, itis useful to quickly determine whether the new cardiac rhythm matches anexisting mapping configuration. If the new cardiac rhythm matches anexisting mapping configuration, the data being acquired can be added toan existing cardiac map or to a new cardiac map associated with thematching mapping configuration. If the new cardiac rhythm does not matchan existing mapping configuration, a new cardiac mapping configurationcan be configured and the data can be added to a new cardiac map or toan existing cardiac map, using the new cardiac mapping configuration.

The present disclosure describes embodiments of systems and methods forquickly determining whether a new cardiac rhythm matches an existingmapping configuration and for quickly configuring a new cardiac mappingconfiguration, thereby potentially maximizing mapping data collectionand reducing frustration.

FIG. 1 is a diagram illustrating an electro-anatomical mapping system 20for mapping multiple different types of cardiac rhythms, which are mixedin time, of a patient 22, according to embodiments described in thedisclosure. The system 20 provides information for determining whether anew cardiac rhythm has been previously mapped using an existing cardiacmapping configuration and information for configuring a new cardiacmapping configuration. Using an existing mapping configuration or a newmapping configuration, the data associated with the new cardiac rhythmcan be added to an existing cardiac map or to a new cardiac map. Withthis information, a user 24 of the system 20, such as a physician and/ora technician, and/or the system 20 itself, can quickly switch to usingeither an existing cardiac mapping configuration that matches the newcardiac rhythm or to a new cardiac mapping configuration.

The system 20 includes a catheter 26 having one or more electrodes.During a signal acquisition stage, the catheter 26 can be displaced tomultiple locations within the heart chamber of interest into which thecatheter 26 is inserted. In some embodiments, the catheter 26 isconfigured for contact mapping. In some embodiments, the catheter 26 isconfigured for near-contact mapping. In some embodiments, the catheter26 is configured for non-contact mapping. In embodiments, the electrodesare mounted on the catheter 26 following a three dimensional oliveshape, where the electrodes are mounted on a device capable of deployingthe electrodes into the desired shape while inside the heart and capableof retracting the electrodes when the catheter is removed from theheart. To allow deployment into the three dimensional shape, theelectrodes may be mounted on a balloon or shape memory material, such asNitinol. In embodiments, the catheter 26 may include any number ofelectrodes arranged according to any desired shape.

In embodiments, the system 20 includes other catheters and/or electrodesfor measuring the electrical activity of the heart. These electrodes canbe externally mounted on or near the patient for measuring theelectrical activity of the heart. For example, the system 20 can includeelectrocardiogram (ECG or EKG) leads that are used to measure theelectrical activity of the heart. The system 20 can use the signalsobtained from the ECG leads for system functions, such as determiningwhich new or existing mapping configuration(s) more closely matches acardiac rhythm and switching to using a different mapping configurationfor adding data to an associated cardiac map.

At each of the locations to which the catheter 26 is moved, thecatheter's one or more electrodes acquire signals resulting from theelectrical activity of the heart. This provides, to the user 24,physiological data pertaining to the heart's electrical activity basedon information acquired at multiple locations, which may facilitate, forexample, providing a relatively accurate reconstruction of thephysiological behavior of the endocardium surface. The acquisition ofsignals at multiple catheter locations in the heart chamber enables thecatheter 26 to effectively act as a “mega-catheter” whose effectivenumber of electrodes and electrode span is proportional to the productof the number of locations in which signal acquisition is performed andthe number of electrodes on the catheter 26. In some embodiments ofnon-contact mapping, to enhance the quality of the physiologicalinformation at the endocardium surface, the catheter 26 is moved to morethan three locations, such as more than 5, 10, or even 50 locations,within the heart chamber. Further, the spatial range over which thecatheter is moved may be larger than one third (⅓) of the diameter ofthe heart cavity, such as larger than 35%, 40%, 50% or even 60% of thediameter of the heart cavity.

In embodiments, the physiological information is computed based onsignals measured over several heart beats, either at a single catheterlocation within the heart chamber or over several locations. Incircumstances where physiological information is based on multiplemeasurements over several heart beats, the measurements can besynchronized with one another so that the measurements are performed,and/or analyzed, with respect to approximately the same phase of theheart cycle. Also, the signal measurements over multiple beats can besynchronized based on features detected from physiological data, suchas, for example, a surface electrocardiogram (ECG) or an intracardiacelectrogram (EGM).

The system 20 includes a processing unit 28, which may be, or include, aprocessor that executes code stored in internal memory 30 and/or in astorage device 32 to perform operations, according to embodiments of thedisclosure. The internal memory 30 and/or the storage device 32 also, oralternatively, may store data acquired by the one or more electrodes ofthe mapping catheter 26. In some embodiments, the internal memory 30and/or the storage device 32 may store data acquired via other cathetersand or external electrodes, such as via ECG leads. In some embodiments,the processing unit 28 is an electronic processor, which may be, atleast in part, a software processor.

The processing unit 28 is communicatively coupled to the catheter 26 andreceives the signals from the one or more electrodes. The processingunit 28 executes, from memory such as the internal memory 30 and/or thestorage device 32, an automated set-up routine that processes thesignals from the one or more electrodes to determine new mappingconfigurations and may provide at least some set-up information and/orset-up results for the new mapping configurations to the user 24. Also,the processing unit 28 executes, from memory such as the internal memory30 and/or the storage device 32, code that processes the signals withbeat detection and beat acceptance criteria for one or more existingmapping configurations. In some embodiments, the existing mappingconfigurations include a current existing mapping configuration beingused to add data to an associated current existing cardiac map and oneor more other existing mapping configurations. This provides informationabout how well the signals match the existing mapping configurations.

In some embodiments, the processing unit 28 executes a reconstructionprocedure to determine the physiological information at the endocardiumsurface. To expedite embodiments of computational operations performedby the system 20, the processing unit 28 may compute, prior to theinsertion of the catheter 26 into the heart chamber and/or before signalacquisition by the catheter's electrodes has commenced, transformationfunctions that can be used, during a mapping procedure, to facilitatethe reconstruction process. Once the catheter 26 is inserted anddisplaced to a particular location in the heart chamber, the mappingprocedure may be performed expeditiously by computing thosetransformation components that were not computed ahead of the signalacquisition stage, and combining those components with the appropriatepre-processed transformation components to obtain the overalltransformation function(s). The overall transformation function may beapplied to the acquired raw data to perform an inverse reconstructionoperation.

The processing unit 28 may also perform a catheter registrationprocedure. The location of the catheter 26 inserted into the heartchamber may be determined using a conventional sensing and trackingsystem (not shown) that provides the three dimensional spatialcoordinates of the catheter 26 and/or its multiple electrodes withrespect to the catheter's coordinate system as established by thesensing and tracking system. However, to perform the mapping procedureand/or reconstruct physiological information on the endocardium surface,it may be desirable to align the coordinate system of the catheter 26with the endocardium surface's coordinate system. The processing unit 28or another processing module of the system 20 may be configured todetermine a coordinate system transformation function that transformsthe three dimensional spatial coordinates of the catheter's locationsinto coordinates expressed in terms of the endocardium surface'scoordinate system, or vice-versa. In some embodiments, the processingunit 28 performs post-processing operations on the reconstructedphysiological information to extract and display useful features of theinformation to the operator of the system 20 and/or other persons, suchas a physician.

The signals acquired by the one or more electrodes of the catheter 26may be passed to the processing unit 28 via a signal conditioning module34 that receives the signals from the catheter 26 and performs signalenhancement operations on the signals before they are forwarded to theprocessing unit 28. Signal conditioning hardware may be used to amplify,filter, and sample intracardiac potential measured by one or moreelectrodes. In some embodiments, for example, the intracardiac signalshave maximum amplitudes of 60 mV and mean amplitudes of a fewmillivolts. In some embodiments the signals are bandpass filtered in afrequency range, such as 0.5-500 Hz, and sampled with analog to digitalconverters, such as converters with 15-bit resolution at 1 kHz.

To avoid interference with electrical equipment in the room, the signalsmay be filtered to remove one or more frequencies corresponding to theequipment. Other types of signal processing operations may beimplemented, such as, for example, spectral equalization, automatic gaincontrol, and/or the like. The resultant processed signals are forwardedby the module 34 to the processing unit 28 for further processing.

The system 20 includes a user interface 36 and, optionally, peripheraldevices, such as a printer 38, which are communicatively coupled to theprocessing unit 28. The user interface 36 includes one or more displaydevices 40 and input devices, such as a mouse 42 and a keyboard 44. Theuser interface 36 may receive signals from the processing unit 28 anddisplay information about which existing mapping configuration(s) moreclosely matches a current cardiac rhythm. In some embodiments, the userinterface 36 may receive signals from the processing unit 28 and displayinformation about whether a current cardiac rhythm more closely matchesa current existing mapping configuration being used to add data to anassociated current existing cardiac map or a different existing mappingconfiguration. Also, the user interface 36 may display information abouta new mapping configuration obtained via the automated set-up routine.In some embodiments, with the user interface 32 displaying thisinformation, the user 24 can quickly and easily determine which mappingconfiguration of the existing mapping configurations and the new mappingconfiguration more closely matches the cardiac rhythm such that it canbe used to add data to an associated cardiac map, including either anexisting cardiac map or a new cardiac map. Also, in some embodiments,the user interface 32 can be used to switch to using one of the existingmapping configurations or a new mapping configuration. In embodiments,the user interface 36 displays this information while the system 20 isadding signals into the current cardiac map. In some embodiments, theuser interface 36 includes a graphical user interface that includes atouch screen, which can be used for switching from using one of theexisting mapping configurations to using another one of the existingmapping configurations or a new mapping configuration and adding thedata to an associated cardiac map that can be an existing cardiac map ora new cardiac map.

FIG. 2 is a flowchart diagram illustrating an automatedelectro-anatomical mapping process, according to embodiments describedin the disclosure. The electro-anatomical mapping process of FIG. 2 maybe performed, at least in part, by the electro-anatomical mapping system20 of FIG. 1. In some embodiments, the processing unit 28 executescomputer code stored in the internal memory 30 and/or storage device 32to facilitate the electro-anatomical mapping process of FIG. 2.

In the electro-anatomical mapping process of FIG. 2, a data stream 100containing multiple signals is input into the system (e.g., the mappingsystem 20 depicted in FIG. 1). The data stream 100 provides a collectionof physiological and non-physiological signals and information thatserve as inputs to the mapping process. The data stream 100 may includesignals received from one or more electrodes on the catheter 26. Also,the data stream 100 may include signals and/or information such asunipolar or bipolar intracardiac EGM signals, ECG signals, electrodeand/or catheter location information originating from a variety ofmethodologies including magnetic, impedance, ultrasound, fluoroscopy,and real time magnetic resonance imaging (MRI) methodologies, tissueproximity information, catheter force or contact information such asfrom force spring sensing, piezo-electric sensing, and optical sensing,catheter tip and/or tissue temperature, acoustic information, catheterelectrical coupling information, respiration phase, blood pressure,and/or other physiological information. In addition, the data stream 100may contain information such as catheter shape and electrode properties.The signals and information can be collected directly by the mappingsystem and/or obtained from another system using an analog or digitalinterface.

A mapping determination process 102 receives the data stream 100 andprocesses the data to provide information for determining whether theacquired signals in the data stream 100 should be added to the currentmap, another existing cardiac map, or a new cardiac map. The mappingdetermination process 102 processes the data with beat detection andbeat acceptance criteria for the current mapping configuration and forone or more other existing mapping configurations to provide informationabout how well the incoming data matches the current mappingconfiguration and the other existing mapping configurations. Also, themapping determination process 102 automatically determines new mappingconfigurations for the incoming data, which may include determining atleast some set-up information and/or set-up results for the new mappingconfigurations. In some embodiments, the mapping determination process102 determines the new mapping configurations in parallel withprocessing the data with the beat detection and the beat acceptancecriteria of the existing mapping configurations, where in parallel canbe by serially switching between determining the new mappingconfigurations and processing the data with the beat detection and thebeat acceptance criteria of the existing mapping configurations. Inembodiments, the mapping determination process 102 continuously (orcontinually) processes the data or signals with beat detection and beatacceptance criteria of the existing mapping configurations such as bysequentially comparing different beat detection and beat acceptancecriteria to the incoming data. In embodiments, the mapping determinationprocess 102 continuously (or continually) determines new mappingconfigurations for the incoming data, such as by analyzing predeterminedtime intervals of data. In embodiments, the mapping determinationprocess 102 continuously (or continually) determines new mappingconfigurations for the incoming data by processing the data at one ormore of a predetermined time interval, once every heart beat cycle, andonce per second.

The mapping determination process 102 processes the data with beatdetection and beat acceptance criteria to provide information about howwell the signals match the existing mapping configurations, includingexisting mapping configurations associated with existing cardiac maps.In embodiments, the mapping determination process 102 processes the datawith beat detection and beat acceptance criteria for the current mappingconfiguration associated with a current existing maps into which thedata are currently being added, and with beat detection and beatacceptance criteria for one or more other existing mappingconfigurations. In embodiments, the mapping determination process 102processes the data with beat detection and beat acceptance criteria forall existing cardiac mapping configurations.

In some embodiments, the mapping determination process 102 displays thedegree of matching between the incoming data and the existing mappingconfigurations via a user interface, such as the user interface 36. Themapping determination process 102 may display the degree of matching fordetermining whether the cardiac rhythms of the incoming data have beenpreviously mapped and to determine which of the existing mappingconfigurations more closely matches the incoming data. The mappingdetermination process 102 may also, or alternatively, display, on theuser interface, information such as set-up information for a new mappingconfiguration for the cardiac rhythm. With this information displayed onthe user interface, the user may quickly and easily determine whetherthe incoming data should continue to be added to the current map, oradded to another existing map or a new cardiac map. In embodiments, themapping determination process 102 displays at least some of the aboveinformation on the user interface while using the current mappingconfiguration of the existing mapping configurations to add incomingdata to the associated current map.

In some embodiments of the mapping determination process 102 and thegeneration of cardiac maps, one or more of the signals in the incomingdata may be used as a reference for triggering and alignment 104 of thedata stream 100 relative to the cardiac rhythm of the incoming data,another biological cycle, and/or an asynchronous system clock. Thetriggering and alignment 104 defines a time instance around which awindow of data from the data stream 100 is sampled. In embodiments, atrigger event is detected from a physiological signal designated as areference signal. The trigger event may be asynchronous to the patientand derived from a system clock. For example, when constructing anactivation map it is common to use an ECG or EGM signal as a reference,and when constructing an anatomical shell, a system clock may providethe trigger events.

Also, when aggregating data from multiple cardiac beats to create anelectro-anatomical map, it may be useful to trigger based on a stablereference in the data stream 100. In that case, the reference providesalignment across beats to a desired phase in the cardiac cycle. Inembodiments, a single signal source is selected for triggering, such asECG lead II, and waveform attributes such as minimum/maximum, absolutemaximum, maximum/minimum slope, and/or first deviation from baseline maybe used to detect a trigger. According to embodiments, using multiplesignals to determine triggering can provide various advantages incomparison to triggering schemes based on a single signal.

The triggering and alignment 104 of the signals results in beat datasetsat 104, and a number of beat metrics 108 are computed for each of thebeat datasets at 104. The beat metrics 108 may be computed usinginformation from a single signal spanning one or more beats, overmultiple signals within the same beat, and/or from multiple signalsspanning multiple beats. The beat metrics 108 provide multiple types ofinformation on the quality of a beat dataset at 104 and the likelihoodthat the beat data in the beat dataset is acceptable for inclusion in amap dataset 110. After the beat metrics 108 are computed, a beatacceptance process 106 aggregates the criteria and decides whether abeat dataset can be added to a particular map dataset 110. Inembodiments, a number of map datasets 110 may be created, where each mapdataset 110 corresponds to a different existing cardiac map.

As indicated previously, in embodiments, the mapping determinationprocess 102 is configured to indicate a degree of matching between theincoming data and one or more of the existing mapping configurations,which include beat detection and beat acceptance criteria that are usedto analyze the incoming data. Also, the mapping determination process102 may provide a new mapping configuration for the incoming data. Auser, e.g., user 24, and/or the system, e.g., system 20, can determine,based at least in part on the degree of matching, whether to 1) continueusing a current mapping configuration to continue adding data to theassociated current map; 2) switch to using another one of the existingmapping configurations and add data to the current map, another existingmap or a new map; or 3) switch to using a new mapping configuration andadd data to the current map, another existing map or a new map. Inembodiments, for example, the mapping determination process 102indicates the degree of matching between the incoming data and at leastone of the existing cardiac mapping configurations by displaying thepercentage of beat datasets at 104 that match each of the existingmapping configurations over a predetermined period of time. In someembodiments, for example, the mapping determination process 102indicates the degree of matching between the incoming data and at leastone of the existing cardiac mapping configurations by displaying thepercentage of beat datasets at 104 that can be added into each of thedifferent map datasets 110 over a predetermined period of time. In someembodiments, metrics other than the percentage of beat datasets at 104that match each of the existing mapping configurations over apredetermined period of time or the percentage of beat datasets at 104that can be added into each of the different map datasets 110 over apredetermined period of time can be used to indicate the degree ofmatching. In some embodiments, metrics that use a subset of the beatacceptance criteria can be used to indicate the degree of matching.

The automated electro-anatomical mapping process of FIG. 2 continueswith a surface map generation process 120 that is employed to generatesurface map data from the map datasets 110 and surface geometry data118. In embodiments, the surface geometry data 118 may be generatedconcurrently, or at least during the same data acquisition process,using identical or different triggering and beat acceptance metricsemploying a surface geometry construction process 112. The surfacegeometry construction process 112 may construct surface geometry usingdata such as electrode locations and catheter shape contained in thedata stream 100. Also, previously collected surface geometry 116 may beused as an input to the surface map data. Such surface geometry 116 maybe collected in the same procedure using a different map dataset orusing a different modality such as CT, MRI, ultrasound, and/orrotational angiography, which is registered to the catheter locatingsystem.

A system, such as system 20, may select the source of the surfacegeometry data at 114 and provide surface geometry data 118 to thesurface map generation process 120. The generation process 120 generatessurface map data 122 that may provide information on cardiac electricalexcitation, cardiac motion, tissue proximity information, tissueimpedance information, force information, and/or any other collectedand/or derived information. Once obtained, the surface map data 122 maybe further processed to annotate desired features from the underlyingdata, a process defined herein as surface map annotation 124. Desiredannotations may include instantaneous potential, activation time,voltage amplitude, dominant frequency and/or other properties of thesignal. Once computed, the annotations may be displayed superimposed onchamber geometry. If the number of annotations is lower than the numberof elements that make up the display of surface geometry, surface mapinterpolation 126 may be employed. Displayed maps 128 may be computedand displayed separately, combined, and/or overlaid on top of eachother.

FIG. 3 is a diagram illustrating a process 148 for determining whichmapping configuration more closely matches the incoming cardiac rhythmsignals, according to embodiments of the disclosure. In someembodiments, the process 148 is part of the mapping determinationprocess 102 that is part of the electro-anatomical mapping process ofFIG. 2.

The process 148 receives the data stream 100 and processes data, such assignals and information, in the data stream 100 to provide informationfor determining which mapping configuration of the existing mappingconfigurations more closely matches the incoming data stream 100 andinformation for a new mapping configuration. The process 148 providesparallel processing paths for the data in the data stream 100.

At 150, the process 148 processes the data with multiple beat detectionand beat acceptance criteria for the existing mapping configurations,which can include a current mapping configuration and one or more otherexisting mapping configurations. For example, in system 20, theprocessing unit 28 may execute, from memory such as the internal memory30 and/or the storage device 32, code that processes the signals withthe beat detection and beat acceptance criteria for the current mappingconfiguration that is used to add data to the current existing cardiacmap and for one or more other existing mapping configurations that mayor may not have been used to add data to an existing cardiac map. Thisprocessing provides information about how well the incoming data matchesthe current mapping configurations and the one or more other existingmapping configurations. In embodiments, the process 148 processes thedata with beat detection and beat acceptance criteria for all existingmapping configurations. In some embodiments, the process 148continuously (or continually) processes the data with the beat detectionand beat acceptance criteria of existing mapping configurations, such asby sequentially comparing different beat detection and beat acceptancecriteria to the incoming data.

At 152, the process 148 automatically determines new mappingconfigurations for at least a portion of the incoming data, whichincludes determining at least some set-up information and/or set-upresults for the new mapping configurations. For example, in system 20,the processing unit 28 may execute, from memory such as the internalmemory 30 and/or the storage device 32, the automated set-up routinethat processes signals from one or more electrodes to determine newmapping configurations and provide at least some set-up informationand/or set-up results for the new mapping configurations to the user 24.

In the process 148, the automated set-up routine can be configured tooperate in a number of different ways. In an example, the automatedset-up routine can be configured to use automatically selectedparameters, such as predetermined default parameters to, at least, begindetermining the new mapping configuration. In another example, theautomated set-up routine can be configured to use multiple parametersand/or iteratively changing the parameters to determine the bestmatching mapping configuration for the incoming data. Also, inembodiments, after the automated set-up routine has determined asuggested new mapping configuration, the process 148 provides signals orother data to the user, which enables the user to validate or modify thesuggested new mapping configuration. Embodiments of the system displaydata that indicates a percentage of the datasets of the incoming datathat would be accepted using the new mapping configuration.

In embodiments, in the process 148, the automated set-up routine runscontinually and, in a given time interval, provides many new mappingconfigurations. Each new mapping configuration is slightly orsignificantly different than previously determined new mappingconfigurations. In some embodiments, the automated set-up routinecombines a number of these previously determined new mappingconfigurations to come up with a new mapping configuration that can bechecked against the incoming data. In some embodiments, the automatedset-up routine averages a number of these previously determined newmapping configurations to come up with a new mapping configuration thatcan be checked against the incoming data. In some embodiments, theautomated set-up routine analyzes the sequence of previously determinednew mapping configuration to determine a new mapping configuration.

As illustrated in FIG. 3, the process 148 determines the new mappingconfigurations in parallel with processing the data with the beatdetection and the beat acceptance criteria of the existing mappingconfigurations. In some embodiments, the process 148 continuously (orcontinually) determines new mapping configurations for the incomingdata, such as by analyzing predetermined time intervals of data. In someembodiments, the process 148 continuously (or continually) determinesnew mapping configurations for the incoming data by processing the dataat one or more of a predetermined time interval, once every heartbeat,and once per second.

At 154, the process 148 displays the degree of matching between theincoming data and the existing mapping configurations via a userinterface, such as the user interface 36. The process 148 displays thedegree of matching to facilitate determining whether the type of cardiacrhythm in the incoming data has been previously mapped and to facilitatedetermining which of the existing mapping configurations more closelymatches the incoming data. In embodiments, the process 148 also displaysinformation about the new cardiac mapping configuration, includingset-up information for the new cardiac mapping configuration for thecardiac rhythm. For example, in system 20, the user interface 36 mayreceive signals from the processing unit 28 and display the informationabout whether a current cardiac rhythm more closely matches the currentmapping configuration or a different existing mapping configuration.Also, the user interface 36 may display information about the newmapping configuration determined by the automated set-up routine. Insome embodiments, the process 148 indicates the degree of matchingbetween the incoming data and at least one of the existing cardiac maps,by displaying the percentage of beat datasets that more closely matcheseach of the existing mapping configurations over a predetermined periodof time. In some embodiments, the process 148 indicates the degree ofmatching between the incoming data and at least one of the existingcardiac maps, by displaying the percentage of beat datasets that can bemapped into each of the different map datasets 110 over a predeterminedperiod of time. In some embodiments, metrics other than the percentageof beat datasets that more closely matches each of the existing mappingconfigurations over a predetermined period of time or the percentage ofbeat datasets that can be mapped into each of the different map datasets110 over a predetermined period of time can be used to indicate thedegree of matching. In some embodiments, metrics that use a subset ofthe beat acceptance criteria can be used to indicate the degree ofmatching. In embodiments, the process 148 displays at least some of theabove information on the user interface while adding incoming data to acurrent map.

In embodiments, at 154, the process 148 determines which mappingconfigurations, including new and existing mapping configurations, areeffectively identical or sufficiently similar to be consideredinterchangeable. The process 148 then analyzes the mappingconfigurations and determines which mapping configurations to show tothe user. In some embodiments, the process 148 prioritizes the mappingconfigurations for display to the user, where prioritizing can depend onfactors such as which mapping configurations are the best match to theincoming data, which are the most recently used, and/or which are themost different from one another.

At 156, a user, such as user 24, determines which mapping configurationmore closely matches the incoming data. The user and/or the systemdetermines whether to 1) continue using a current mapping configurationto continue adding data to the associated current map, 2) switch tousing another one of the existing mapping configurations and add data tothe current map, another existing map or a new map, or 3) switch tousing a new mapping configuration and add data to the current map,another existing map or a new map. The user analyzes the displayedinformation and can select a different mapping configuration and adifferent cardiac map, such as by using a mouse or a keyboard or atouchscreen. Also, in some embodiments, the system 20, using a set ofheuristic rules, automatically determines which mapping configuration touse and, if needed, switches to adding the incoming data into adifferent map.

FIG. 4 is a diagram illustrating a user interface display 200 thatdisplays the degree of matching between the incoming data and threeexisting cardiac mapping configurations, according to embodiments of thedisclosure. The display 200 displays results for the current mappingconfiguration and two other existing mapping configurations. Inembodiments, the display 200 can be configured to display results forany number of existing mapping configurations such as, for example, oneexisting mapping configuration, two existing mapping configurations,three existing mapping configurations, four existing mappingconfigurations, five existing mapping configurations, and/or the like.As shown in FIG. 4, embodiments of the display 200 include a currentmapping configuration result display 202, an auto-map (automated set-uproutine) display 204, a first existing mapping configuration resultdisplay 206, and a second existing mapping configuration result display208. In some embodiments, the first and second existing mappingconfiguration result displays 206 and 208 display information for thetwo existing cardiac mapping configurations, other than the currentmapping configuration, that have (or would have if they were the currentmap) the highest beat dataset acceptance rates, such as acceptance ofthe most beat datasets in a predetermined time period. In someembodiments, the display 200 displays at least the current mappingconfiguration result display 202 and the first existing mappingconfiguration result display 206. In some embodiments, the predeterminedtime period is a value such as, for example, 10 seconds.

The current mapping configuration result display 202 provides anindication of the beat dataset acceptance rate of the current mappingconfiguration. The first existing mapping configuration result display206 provides an indication of what the beat dataset acceptance ratewould be for the first existing mapping configuration, and the secondexisting map result display 208 provides an indication of what the beatdataset acceptance rate would be for the second existing mappingconfiguration.

In some embodiments, the current mapping configuration result display202, the first existing mapping configuration result display 206, andthe second existing mapping configuration result display 208, displaycolors to indicate the beat dataset acceptance rates. For example, thedisplays can be color coded to display green (G), yellow (Y), or red(R), where green indicates an acceptable acceptance rate, yellow a loweracceptance rate than green and a higher acceptance rate than red, andred an unacceptable acceptance rate. In some embodiments, for example, agreen acceptance rate is greater than or equal to 60%, a red acceptancerate is less than or equal to 40%, and a yellow acceptance rate isbetween 40 and 60%. In some embodiments, other ranges for assigningacceptance categories may be used, other indicators for indicatingranges of beat acceptance rates may be used, and/or the like. Forexample, instead of, or in addition to, colors, embodiments may utilizeshapes (e.g., a number of horizontal bars such as those commonly used toindicate network signal strength), sounds, symbols, and/or combinationsof these.

In some embodiments, one or more of the current mapping configurationresult display 202, the first existing mapping configuration resultdisplay 206, and the second existing mapping configuration resultdisplay 208, display percentages that indicate the acceptance rate forthe corresponding cardiac mapping configuration. In other embodiments, adifferent number of colors, other suitable colors, and/or otheracceptance rate percentages for the different colors can be used fordisplaying the degree of matching between the incoming data and theexisting cardiac maps, including the current map.

In some embodiments, the auto-map (automated set-up routine) display 204provides one or more visual indications such as, for example, colors toindicate whether a new cardiac mapping configuration is ready orsatisfactory for use. For example, the display may be color coded todisplay green, yellow, or red, where green indicates a new cardiacmapping configuration has been configured and is ready for use, yellowindicates that the new cardiac mapping configuration may not be readyfor use, and red indicates the new cardiac mapping configuration is notready for use. In some embodiments, a green display indicates thatgreater than or equal to 60% of the beat datasets would be accepted bythe new cardiac mapping configuration, a yellow indicates that between40 and 60% of the beat datasets would be accepted by the new cardiacmapping configuration, and a red indicates that less than or equal to40% of the beat datasets would be accepted by the new cardiac mappingconfiguration. In some embodiments, the auto-map display 204 displayspercentages that indicate what the acceptance rate would be for the newcardiac mapping configuration. In other embodiments, a different numberof colors, other suitable colors, other acceptance rate percentagesand/or ranges for the different colors, different indicators such as,for example, shapes, sounds, symbols, and/or the like may be used.

In one example, assuming that the predetermined time period fordetermining acceptance rates is 10 seconds and that one beat dataset isprovided per second, then 10 beat datasets are provided during a 10second time period. Also, assuming that the cardiac rhythm has beensteady for greater than 10 seconds and that all beat datasets during themost recent 10 second interval have been added to the current map, thenthe current mapping configuration result display 202 might be greenand/or display 100%, the auto-map display 204 might be green and/ordisplay 100%, and the first and second existing mapping configurationresult displays 206 and 208 might be red and/or display 0%. In addition,the percentages given for color changes in the preceding paragraphs areused in this example.

To begin, according to this example, the cardiac rhythm changes, and thefirst new beat dataset is not added to the current map. Instead, thefirst new beat dataset would be added to the map associated with thefirst existing mapping configuration. Thus, only 9 out of the last 10beat datasets have been added to the current map and the current mappingconfiguration result display 202 will remain green and/or display 90%,the first existing mapping configuration result display 206 will remainred and/or display 10%, the second existing mapping configuration resultdisplay 208 will remain red and/or display 0%, and the auto-map display204 will remain green and/or display 90%.

Assuming that the cardiac rhythm remains as previously changed, the newbeat datasets are not added to the current map but would be mapped intothe map associated with the first existing mapping configuration and notthe map associated with the second existing mapping configuration. Thus,after a second new beat dataset, the current mapping configurationresult display 202 will remain green and/or display 80%, the firstexisting mapping configuration result display 206 will remain red and/ordisplay 20%, the second existing mapping configuration result display208 will remain red and/or display 0%, and the auto-map display 204 willremain green and/or display 80%. At this point, the user would likelycontinue mapping into the current map using the current mappingconfiguration.

After third and fourth new beat datasets, the current mappingconfiguration result display 202 will remain green and/or display 60%,the first existing mapping configuration result display 206 will remainred and/or display 40%, the second existing mapping configuration resultdisplay 208 will remain red and/or display 0%, and the auto-map display204 will remain green and/or display 60%. At this point, the user wouldlikely continue adding data to the current map using the current mappingconfiguration, but may notice the change in acceptance percentages.

After a fifth new beat dataset, the current mapping configuration resultdisplay 202 will turn yellow and/or display 50%, the first existingmapping configuration result display 206 will also turn yellow and/ordisplay 50%, the second existing mapping configuration result display208 will remain red and/or display 0%, and the auto-map display 204 willturn yellow and/or display 50%. At this point, the user may start tolook for a different cardiac mapping configuration and the user willlikely notice that the first existing mapping configuration resultdisplay 206 has turned yellow.

After a sixth new beat dataset, the current mapping configuration resultdisplay 202 will turn red and/or display 40%, the first existing mappingconfiguration result display 206 will turn green and/or display 60%, thesecond existing mapping configuration result display 208 will remain redand/or display 0%, and the auto-map display 204 will turn red and/ordisplay 40%. At this point, the user will see that the first existingmapping configuration is likely the next cardiac mapping configurationto be selected. Also, at this point, the automated set-up routine maydetermine a new cardiac mapping configuration based on five or six newbeat datasets.

After the seventh or more new beat datasets, the current mappingconfiguration result display 202 will remain red and/or display 30% orless, the first existing mapping configuration result display 206 willremain green and/or display 70% or more, and the second existing mappingconfiguration result display 208 will remain red and/or display 0%. Ifthe automated set-up routine determines a new cardiac mappingconfiguration based on the five or six new beat datasets, the auto-mapdisplay 204 will turn green and/or display 70% or more. At this point,the user will likely switch to the first existing mapping configuration,which is then used as the new current mapping configuration, and theprocess continues.

In another example, assuming that the predetermined time period fordetermining acceptance rates is 10 seconds and that one beat dataset isprovided per second, then 10 beat datasets are provided during a 10second time period. Also, assuming that the cardiac rhythm has beensteady for greater than 10 seconds and that all beat datasets during themost recent 10 second interval have been added to the current map, thenthe current mapping configuration result display 202 will be greenand/or display 100%, the auto-map display 204 will be green and/ordisplay 100%, and the first and second existing mapping configurationresult displays 206 and 208 will be red and/or display 0%. In addition,the percentages given for the color changes in the preceding paragraphsare used for the color changes in this example.

To begin, the cardiac rhythm changes, and the first new beat dataset isnot added to the current map or to either of the maps associated withthe first and second existing mapping configurations. Instead, the firstnew beat dataset is part of a completely new cardiac rhythm. Thus, only9 out of the last 10 beat datasets have been added to the current mapand the current mapping configuration result display 202 will remaingreen and/or display 90%, the first existing mapping configurationresult display 206 will remain red and/or display 0%, the secondexisting mapping configuration result display 208 will remain red and/ordisplay 0%, and the auto-map display 204 will remain green and/ordisplay 90%.

Assuming that the cardiac rhythm remains as previously changed, the newbeat datasets will not be added into the current map or to either of themaps associated with the first and second existing mappingconfigurations. Thus, after second, third, and fourth new beat datasets,the current mapping configuration result display 202 will remain greenand/or display 60%, the first existing mapping configuration resultdisplay 206 will remain red and/or display 0%, the second existingmapping configuration result display 208 will remain red and/or display0%, and the auto-map display 204 will remain green and/or display 60%.At this point, the user would likely continue adding data to the currentmap.

After a fifth new beat dataset, the current mapping configuration resultdisplay 202 will turn yellow and/or display 50%, the first existingmapping configuration result display 206 will remain red and/or display0%, the second existing mapping configuration result display 208 willremain red and/or display 0%, and the auto-map display 204 will turnyellow and/or display 50%. At this point, the user can start looking fora different cardiac mapping configuration and will notice that theauto-map display 204 has turned yellow.

After a sixth new beat dataset, the current mapping configuration resultdisplay 202 will turn red and/or display 40%, the first existing mappingconfiguration result display 206 will remain red and/or display 0%, thesecond existing mapping configuration result display 208 will remain redand/or display 0%, and the auto-map display 204 will turn red and/ordisplay 40%. At this point, the user will see that the auto-map display204 has turned red and the automated set-up routine may determine a newcardiac mapping configuration based on five or six new beat datasets.

After the seventh or more new beat datasets, the current mappingconfiguration result display 202 will remain red and/or display 30% orless, the first existing mapping configuration result display 206 willremain red and/or display 0%, and the second existing mappingconfiguration result display 208 will remain red and/or display 0%. Ifthe automated set-up routine determines a new cardiac mappingconfiguration based on five or six new beat datasets, the auto-mapdisplay 204 will turn green and/or display 70% or more. At this point,the user will likely switch to adding the data into a map associatedwith the new cardiac mapping configuration determined by the automatedset-up routine, which then becomes the new current mappingconfiguration, and the process continues.

Various modifications and additions can be made to the exemplaryembodiments discussed without departing from the scope of the presentdisclosure. For example, while the embodiments described above refer toparticular features, the scope of this disclosure also includesembodiments having different combinations of features and embodimentsthat do not include all of the described features. Accordingly, thescope of the present disclosure is intended to embrace all suchalternatives, modifications, and variations as fall within the scope ofthe claims, together with all equivalents thereof.

We claim:
 1. A system for providing information about a patient's heart,comprising: one or more electrodes that receive signals from electricalactivity of the heart over one or more heart beat cycles; and anelectronic processor coupled to the one or more electrodes to: receivethe signals from the one or more electrodes; execute an automated set-uproutine that processes the signals to automatically provide at leastsome set-up results for new mapping configurations; and process thesignals with beat detection and beat acceptance criteria for the new orexisting mapping configurations to provide information about how wellthe signals match one or more of the new or existing mappingconfigurations.
 2. The system of claim 1, wherein the electronicprocessor executes the automated set-up routine and processes thesignals with the beat detection and beat acceptance criteria for theexisting mapping configurations in parallel.
 3. The system of claim 1,wherein the electronic processor executes the automated set-up routineat one or more of a predetermined time interval, once every heart beatcycle, and once per second.
 4. The system of claim 1, wherein theautomated set-up routine provides the new mapping configurations inresponse to changes in the signals and the new mapping configurationsare updated and displayed while matching the signals to one or more ofthe new or existing mapping configurations.
 5. The system of claim 1,comprising: a user interface, wherein the degree of matching between thesignals and at least two of the new or existing mapping configurationsis displayed on the user interface.
 6. The system of claim 1,comprising: a user interface, wherein information for making adetermination about which of the new or existing mapping configurationsmost closely matches the signals is displayed on the user interface. 7.The system of claim 1, comprising: a user interface for switching frommapping the signals using one of the existing mapping configurations tomapping the signals using another one of the existing mappingconfigurations or one of the new mapping configurations.
 8. The systemof claim 1, wherein the electronic processor determines which of the newmapping configurations and the existing mapping configurations areredundant.
 9. The system of claim 1, wherein the electronic processorautomatically switches from mapping the signals using one of theexisting mapping configurations to mapping the signals using another oneof the existing mapping configurations or one of the new mappingconfigurations.
 10. A system for providing information about a patient'sheart, comprising: one or more electrodes that receive signals fromelectrical activity of the heart over one or more heart beat cycles; anelectronic processor coupled to the one or more electrodes to: receivethe signals from the one or more electrodes; execute an automated set-uproutine that processes the signals to automatically provide at leastsome set-up results for new mapping configurations; and process thesignals with beat detection and beat acceptance criteria for existingmapping configurations to provide information about how well the signalsmatch the existing mapping configurations, wherein the electronicprocessor executes the automated set-up routine and processes thesignals with the beat detection and beat acceptance criteria for theexisting mapping configurations in parallel; and a user interface,wherein information for making a determination about which of theexisting mapping configurations more closely matches the signals isdisplayed on the user interface.
 11. The system of claim 10, wherein theautomated set-up routine provides the new mapping configurations inresponse to changes in the signals and the new mapping configurationsare updated and displayed on the user interface.
 12. The system of claim10, wherein the degree of matching between the signals and a currentmapping configuration of the existing mapping configurations isdisplayed on the user interface while mapping the signals to a currentmap associated with the current mapping configuration and the degree ofmatching between the signals and at least one other mappingconfiguration of the existing mapping configurations is displayed on theuser interface while mapping the signals to the current map.
 13. Thesystem of claim 10, wherein a user can switch from mapping the signalsusing a current mapping configuration of the existing mappingconfigurations to mapping the signals using another one of the existingmapping configurations or one of the new mapping configurations via theuser interface.
 14. The system of claim 10, wherein the electronicprocessor is configured to automatically switch from mapping the signalsusing a current mapping configuration of the existing mappingconfigurations to mapping the signals using another one of the existingmapping configurations or one of the new mapping configurations.
 15. Amethod for providing information about a patient's heart, comprising:receiving signals from electrical activity of the heart over one or moreheart beat cycles at one or more electrodes; receiving the signals at anelectronic processor that is coupled to the one or more electrodes;executing, by the electronic processor, an automated set-up routine thatprocesses the signals to automatically provide at least some set-upresults for new mapping configurations; and processing the signals, bythe electronic processor, with beat detection and beat acceptancecriteria for existing mapping configurations to provide informationabout how well the signals match one or more of the existing mappingconfigurations.
 16. The method of claim 15, wherein executing theautomated set-up routine and processing the signals with the beatdetection and beat acceptance criteria for the existing maps isperformed in parallel.
 17. The method of claim 15, comprising:displaying information about the degree of matching between the signalsand a current mapping configuration of the existing mappingconfigurations; and displaying information about the degree of matchingbetween the signals and at least one other mapping configuration of theexisting mapping configurations.
 18. The method of claim 15, comprising:updating the new mapping configurations in response to changes in thesignals; and displaying updated new mapping configurations.
 19. Themethod of claim 15, comprising: switching from mapping the signals usingone of the existing mapping configurations to mapping the signals usinganother one of the existing mapping configurations or one of the newmapping configurations.
 20. The method of claim 15, comprising:determining which of the new mapping configurations and the existingmapping configurations more closely matches the signals; and determiningwhich of the new mapping configurations and the existing mappingconfigurations are redundant.